230 W. Towne Ridge Parkway, Ste. 200, Sandy, Utah 84070 Phone: 801-542-8856 Email: holly@slrealtors.com ARBITRATION FORM #A-1
GREI
VANCE COMMITTEE
FIL
ED ON: ____________
INSTRUCTIONS
1. Please download, fill, save, and electronically submit this form to holly@slrealtors.com.
2. Once submitted, your request will be presented to the Grievance Committee of the Salt Lake Board of Realtors®.
SEC
TION 1
COMPLAINANT & RESPONDENT INFORMATION
COM
PLAINANT(S)
Principal Broker: __________________________________________ ___________________________________________
Name Company (if applicable)
Agent: ___________________________________________ ___________________________________________
Name Company (if applicable)
RESP
ONDENT(S):
Principal Broker: __________________________________________ ___________________________________________
Name Company (if applicable)
Age
nt: ___________________________________________ ___________________________________________
Name Company (if applicable)
SEC
TION 2
PRIMARY COMPLAINANT CONTACT INFORMATION
FIRST NAME: __________________________ MIDDLE NAME: __________________ LAST NAME: ___________________________
PHONE: ____________________________________________ HOME CELL WORK OTHER
EMAIL ADDRESS: ______________________________________________________________________________________________
HOME ADDRESS: ______________________________________________________________________________________________
CITY: ________________________________________ STATE: _______________________ ZIP: ___________________________
GENDER: Male Female Non-binary
ARBITRATION REQUEST & AGREEMENT FORM
230 W. Towne Ridge Parkway, Ste. 200, Sandy, Utah 84070 Phone: 801-542-8856 Email: holly@slrealtors.com ARBITRATION FORM #A-1
SECTION 3 CURRENT PROCEEDINGS
Check the appropriate box, as the statement applies to you.
Ar
e the circumstances giving rise to this arbitration request involved in a civil or criminal litigation OR in any proceeding before
the state real estate licensing authority (Utah Division of Real Estate) OR any other state or federal regulatory or administrative
agency OR other Realtor® association?
SECTION 4 ACKNOWLEDGEMENTS & AGREEMENTS
PRIMARY COMPLAINANT: Please initial each box and sign below. Have any additional complainants sign below.
I (PRIMARY COMPLAINANT) understand by becoming and remaining a member of the Salt Lake Board of Realtors® (or its MLS), I have
consented to arbitration through the Board, under its rules and regulations.
It is my understanding that each respondent is currently a member in good standing of the Board (or its MLS), or was so at the time the
dispute arose.
I am submitting this request for arbitration, as a dispute arising from real estate business as defined by Article 17 of the Code of Ethics
exists between me (the primary complainant) or my firm and the aforementioned respondent(s).
My claim (predicated upon the attached statement, marked as Exhibit 1 and incorporated by reference into this application) is that there is
due, unpaid and owing to me, from the aforementioned respondents the sum of $______________________.
I request and consent to arbitration through the Board, in accordance with the NAR’s Code of Ethics and Arbitration Manual (alternatively,
“in accordance with the professional standards procedures set forth in the Bylaws of the Board”), and I agree to abide by the arbitration
award and to comply with it promptly, even if it is not in my favor.
If I do not comply with the arbitration award and it becomes necessary for any party to this arbitration to obtain judicial confirmation and
enforce the arbitration award against me, I agree to pay the party obtaining such confirmation the costs incurred, including reasonable
attorney’s fees.
I understand that I may be represented by legal counsel, and that I should provide written notice of the name, address, and phone number
of my attorney to all parties and to the Board at least 15 days prior to the hearing. Failure to provide this notice may result in a continuance
of the hearing if the Hearing Panel determines that the other parties have the right to representation and must be given time to obtain it.
I acknowledge that each party must give the Board and all other involved parties a list of the names of witnesses they intend to call at the
hearing, no less than 15 days prior to the hearing. Each party shall arrange for their witnesses to be present at the time and place
designated for the hearing.
I name the following individual as a non-principal Realtor® association member who is affiliated with my firm and has a financial interest in
the outcome of the proceedings. As such, this person has the right to be present throughout the hearing:
Non-principal RealtoAssociation Member: _________________________________________________________
I declare that this application and the allegations made herein are true and correct to the best of my knowledge and belief and that this
request for arbitration has been filed within 180 days of the closing of the transaction, if any, or within 180 days of the discovery of the
facts constituting the arbitrable matter could have been known through exercising reasonable due diligence, whichever was later.
I recognize that if either party to an arbitration request believes that the Grievance Committee has incorrectly classified the issue
presented in the request (i.e. mandatory or voluntary), the party has 20 days from the date of receipt of the Grievance Committee’s
decision to file a written appeal. Only those materials in the Grievance Committee’s pocession at the time of its determination may
be considered by the Board of Director as part of the appeal.
PRIMARY COMPLAINANT SIGNATURE: ____________________________________ DATE: ___________________
ADDITIONAL COMPLAINANT SIGNATURE: __________________________________ DATE: ___________________
YES NO
If you answered yes, please provide a written explanation as a separate page and attach it to this application.